3rd stage of labour

Question 1

Define this stage of labour

Answer 1

The time from the birth of the baby to the expulsion of the placenta and membranes

Question 2

Name the 3 phases

Answer 2

Latent, Detachment, Expulsion

Question 3

Describe the latent phase
When ?
what happens
blood vessels begin to ?

Answer 3

1st stage
From birth of the baby to the beginning of the seperation of the placenta
Myometrium begins to thicken around the placenta , not over the placenta , blood vessels retract

Question 4

Describe the detachment phase
What happens
Clot

Answer 4

detachment of the placenta from the uterine wall by the thickening of the wall behind the placenta
retroplacental clot forms behind the placenta

Question 5

Describe the expulsion phase
whats happens
what causes it to fold

Answer 5

from the seperation from the wall to expulsion through the vagina.
It folds due to strong contraction
Done via gravity and maternal effort

Question 6

Describe the Matthew Duncan and the Schulze way of placental seperation

Answer 6

M D : placenta slips from the vagina sideways, maternal side with the membranes come out first . causes more bleeding and ragged membranes
S : ‘cleaner’ fetus side first and membranes fold in on themselves

Question 7

4 stages to controlling blood loss / haemostasis

1. pressure
2. clamps
3. clots and mesh
4. oxytocin

Answer 7

1. The empty uterus contracts, exerting pressure on the placental site
2. The uterine muscle fibres retract the blood vessels acting as clamps.
3. clot formation in the torn vessels, covering the site in fibrin mesh
4. BF and skin to skin releases oxytocin which enhances contractility

Question 8

2 types of management of the 3rd stage

Answer 8

Active : drugs

Physiological : Natural

Question 9

What is controlled cord traction

Is controlled cord traction used in physiological management ?

Answer 9

Protection of the uterus , done when a contraction comes or else there is a risk of uterine inversion , follow curve of carus
No

Question 10

How long is physiological management left for before intervention ?
risks ?

Answer 10

after 30 mins an obstetrician is informed, after an hour a drug is considered. Due to risks of PPH and retained placenta

Question 11

What drugs are used in active management
Mix of syntometrin
drug of choice now

Answer 11

oxytocic
(oxytocin and ergometrin)
syntoconin = oxytocin IV

Question 12

How long can the cord be left unclamped before controlled cord traction ? why?

Answer 12

5 mins

the cervix may start to close after them 5 mins

Question 13

3 benefits to Delayed cord clamping to baby

Answer 13

1. higher Hb conc
2. lower risk of iron deficiency
3. greater vascular stability

Question 14

2 membranes of the placenta that should be there

Answer 14

amnion (inside) and chorion(outside)

Question 15

Vessels of cord

Answer 15

2 arteries and 1 big vein

Question 16

what to check for on the placenta ?

Answer 16

calcification
infarction 
succenturiate (extra lobe) 
cord insertion  
true and false knots

Question 17

When do cord bloods need to be taken ?

Answer 17

If mums blood group is rhesus -

Question 18

At what time period is a placenta ‘retained’?

Answer 18

after 30 mins of physiological

after an hour of active

Question 19

What is classes as normal blood loss for vaginal delviery ? PPH?

normal for CS? PPH?

Answer 19

500mls = normal
1000mls = PPH

1000 = normal
1500mls = PPH

Question 20

RCOG classifications of perineal tears

Answer 20

1st - just perineal skin
2nd - skin and vaginal / perineal muscle
3rd - skin , muscle and anal sphincter
3a. less than 50% of external AS
3b. more than 50% of external AS
3c. both external AS and internal AS
4th - internal and external AS and anorectal mucosa